“因虚致瘀”论治原发性血小板增多症疾病后期思路探析

Exploration of therapeutic approaches for advanced-stage essential thrombocythemia on “blood stasis caused by deficiency”

关键词:  原发性血小板增多症  积聚  因虚致瘀  气血  阴阳

Key words:  essential thrombocythemia  accumulation  blood stasis caused by deficiency  qi and blood  yin and yang

摘要:

原发性血小板增多症（ET）是一种以外周血中血小板计数增多为主要临床特点的骨髓增殖性肿瘤，主要临床表现为血栓形成和出血倾向，西医治疗根据危险分层以血栓预防、降血小板治疗为主，其毒副作用较大，不良反应多，严重影响了患者的生活质量。原发性血小板增多症初期多因外感内伤使病邪结聚体内，正邪相争多以实为主，随着病情进展，机体受实邪攻伐，久之易使气血阴阳亏虚，虚可致瘀。团队基于临床观察及对名老中医诊治ET经验进行总结，提出ET疾病后期“因虚致瘀”理论，认为ET病因是先天禀赋不足，后天失养，加之邪气攻伐以致瘀血内生。文章从脏腑功能减弱、气血阴阳失和角度分析其发病的内在病机，以“补虚消瘀”为基本治则，从肝、脾、肾论治，并附验案1则以佐证。

Abstract:

Essential thrombocytosis（ET） is a myeloproliferative tumor characterized by increased platelet count in peripheral blood. The main clinical manifestations are thrombosis and bleeding tendency. Western medicine treatment is mainly based on thrombosis prevention and platelet lowering treatment according to risk stratification. Its side effects are large，and there are many adverse reactions，which seriously affect the quality of life of patients. In the early stage of essential thrombocythemia，exogenous and internal injuries caused the accumulation of pathogenic factors in the body，the struggle between healthy qi and pathogenic factors，and the excess as the main. With the progress of the disease，it is attacked by the excess and pathogenic factors. Over time，it is easy to make qi，blood，yin and yang deficiency，deficiency can cause blood stasis. Based on the clinical observation and the summary of the experience of famous old Chinese medicine doctors in the diagnosis and treatment of ET，the author and the team of our department put forward the theory of “blood stasis caused by deficiency” in the later stage of ET disease，and believed that the cause of ET is the lack of congenital endowment，acquired dystrophy，combined with the attack of evil qi，resulting in endogenous blood stasis. The author analyzes the internal pathogenesis of the disease from the perspective of weakened function of zang-fu organs and disharmony of qi，blood，yin and yang. Taking “tonifying deficiency and removing blood stasis” as the basic treatment principle，the treatment is based on the three zang-organs of liver，spleen and kidney，and one proven case is attached for evidence.